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<title>Application to Uppsala International Summer Session 2009</title>
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	<h1>Application to Uppsala International Summer Session 2010</h1>
	{disclaimer}
  {debug}
	
	<form action="#" method="post" enctype="multipart/form-data" name="uissform" id="uissform" onsubmit="return validate();">
	<div id="fieldsets">

	<div class="fieldset" id="step1"><div class="legend">Level</div> <!-- legend -->
      <p class="attend">A placement test, provided by Folksuniversitetet, is used to determine your 
	                    current level.<br/> 
						This is not necessary for absolute beginners.
						<br/><br/>
	                    If you are no beginner, please take the placement test before
	                    filling in this application form.<br/>
						<a href="http://www.folkuniversitetet.se/templates/PageFrame.aspx?id=19417">Click here to proceed to the placement test of Folksuniversitetet (you will leave this site).</a><br/>
						
        {radioset studentlevel beginner I am a beginner}<br/>
        {radioset studentlevel advanced I am no beginner and I have taken the placement test}<br/>
	  </p>
    </div> <!-- fieldset -->
	
	<div class="fieldset" id="step2"><div class="legend">Placement test</div> <!-- legend -->
      <p class="attend">
        My number of <span id="correct_answers_label">correct answers</span> = <span class="fill-in">{fill-in correct_answers}</span> in <span id="level_label">level</span>
        <label>{radioset level A Level A}</label>
        <label>{radioset level B Level B}</label>
        <label>{radioset level C Level C}</label>
	  </p>
    </div> <!-- fieldset -->

	<div class="fieldset" id="step3"><div class="legend">Participation</div> <!-- legend -->
	  <p class="attend">{dropdown sessions sessions choose I wish to attend the:}</p>
	  <p class="attend">{dropdown morning morning choose I wish to participate in the following morning course:}</p>
	  <p class="attend">{dropdown afternoon1 afternoon1 choose I wish to participate in the following afternoon course (June 20 - July 16): }</p>
	  <p class="attend">{dropdown afternoon2 afternoon2 choose I wish to participate in the following afternoon course (July 18 - August 13): }</p>
	</div> <!-- fieldset --> 
	
	<input type="hidden" name="sendtouiss" value="sendtouiss"/>	
	
	<div class="fieldset" id="step4"><div class="legend">Name and address</div> <!-- legend -->
	  <table>
		<tr>
          <td class="fill-in">{dropdown title titles choose}</td>
          <td class="fill-in">{fill-in family_name}</td>
          <td class="fill-in">{fill-in first_name}</td>
          <td class="fill-in">{datepicker date_of_birth}</td>
        </tr>
        <tr>
          <td class="label" id="title_label">Title</td>
          <td class="label" id="family_name_label">Family name</td>
          <td class="label" id="first_name_label">First name</td>
          <td class="label" id="date_of_birth_label">Date of birth (YYYY-MM-DD)</td>
        </tr>
        <tr>
          <td class="fill-in" colspan="2">{fill-in street}</td>
          <td class="fill-in">{fill-in zip_code}</td>
          <td class="fill-in">{fill-in city}</td>
        </tr>
        <tr>
          <td colspan="2" class="label" id="street_label">Street</td>
          <td class="label" id="zip_code_label">Zipcode (postal code)</td>
          <td class="label" id="city_label">City</td>
        </tr>
        <tr>
          <td class="fill-in" colspan="2">{dropdown country countries choose}</td>
          <td class="fill-in" colspan="1">{dropdown nationality nationalities choose}</td>
          <td class="fill-in" colspan="1">{dropdown usstate usstates choose}</td>
        </tr>
        <tr>
          <td colspan="2" class="label" id="country_label">Country</td>
          <td colspan="1" class="label" id="nationality_label">Nationality</td>
          <td colspan="1" class="label" id="usstate_label">State</td>
        </tr>
        <tr>
          <td class="fill-in" colspan="4">{fill-in e-mail}</td>
        </tr>
        <tr>
          <td colspan="4" class="label" id="e-mail_label">E-mail</td>
        </tr>
        <tr>
          <td class="fill-in" colspan="2">{fill-in telephone}</td>
          <td class="fill-in" colspan="2">{fill-in fax}</td>
        </tr>
        <tr>
          <td colspan="2" class="label" id="telephone_label">Telephone number (also country &amp; area code)</td>
          <td colspan="2" class="label">Fax number (also country &amp; area code)</td>
        </tr>
        <tr>
          <td class="fill-in" colspan="2">{fill-in profession}</td>
          <td class="fill-in">{fill-in university}</td>
          <td class="fill-in">{fill-in major_department}</td>
        </tr>
        <tr>
          <td colspan="2" class="label">Profession</td>
          <td class="label">University</td>
          <td class="label">Major department</td>
        </tr>
      </table>
    </div> <!-- fieldset -->
    
    <div class="fieldset" id="step5"><div class="legend">Photo</div> <!-- legend -->
	  <p> Please upload a picture of yourself. This picture will be used for your student id card.</p>
    <p> To start uploading please click on the area below.</p>
      {fileupload photo}
	  <p class="disclaimer">WARNING: only proceed to the next page if you have uploaded and <br/>
	                      can see your picture!</p>


	</div> <!-- fieldset -->

	<div class="fieldset" id="step6"><div class="legend">Boarding or tuition only</div> <!-- legend -->
      <table>
        <tr>
          <td>{radioset tuition_only yes I wish to attend the program 'tuition only' 13.000 SEK per 4 weeks, 6.700 SEK per 2 weeks}</td>
        </tr>
        <tr>
          <td>{radioset tuition_only no I would like to see the boarding options}</td>
        </tr>
      </table>
	</div> <!-- fieldset -->

	
	<div class="fieldset" id="step7"><div class="legend">I wish to reside in a</div> <!-- legend -->
      <table>
        <tr>
          <td>{radioset accommodation SINGLE single room}</td>
        </tr>
        <tr>
          <td>{radioset accommodation DOUBLET doublet <span class="small">(a small unit of two single rooms with kitchenette and bathroom, limited availability)</span>}</td>
        </tr>
        <tr>
          <td class="sup">{radioset accommodation APPT apartment, single occupancy <sup>*</sup>}</td>
        </tr>
        <tr>
          <td class="sup">{radioset accommodation 4a apartment, shared with other student <sup>*</sup>}</td>
        </tr>
        <tr>
          <td class="sup">{radioset accommodation 4b apartment, shared with friend <sup>*</sup>}</td>
        </tr>
        <tr>
          <td class="sup">{radioset accommodation 4c apartment, shared with partner <sup>*</sup>}</td>
        </tr>
        <tr>
          <td class="sup">{radioset accommodation 5 apartment with non participant partner <sup>*</sup>}</td>
        </tr>
        <tr>
          <td style="padding-left: 50px;">with <span class="fill-in">{fill-in number_of_children 100}</span> children</td>
        </tr>
        <tr>
          <td>{radioset accommodation 6 I will arrange my own accommodation, reduction in cost 3.000 SEK per 4-week period}</td>
        </tr>
        <tr>
          <td>{radioset accommodation 7 apartment, single occupancy or with non-participant partner: 4.000 SEK per 4 weeks, 2.400 SEK per 2 weeks}</td>
        </tr>
        <tr>
          <td>{radioset accommodation 8 apartment, shared with participating friend, partner or other student: 1.500 SEK per person per 4 weeks}</td>
        </tr>
        <tr>
          <td class="sup remark"><sup>*</sup> extra costs</td>
        </tr>
      </table>
    </div> <!-- fieldset -->
    
    
	<div class="fieldset" id="step8"><div class="legend">Special wishes</div> <!-- legend -->
      <table>
        <tr>
          <td>{checkbox car I will arrive with my car}</td>
        </tr>
        <tr>
          <td>{checkbox special_vegetarian I would like to request vegetarian meels}
            {radioset vegetarion nofish no fish}
            {radioset vegetarion fish with fish}</td>
        </tr>
      </table>
    </div> <!-- fieldset -->

	<div class="fieldset" id="step9"><div class="legend">Proficiency in languages</div> <!-- legend -->
      <table>
        <tr>
          <th>Language</th>
          <th>Reading</th>
          <th>Speaking</th>
          <th>Writing</th>
        </tr>
        <tr>
          <td id="english_label">English</td>
          <td>{dropdown english_reading fluency1 not}</td>
          <td>{dropdown english_speaking fluency1 not}</td>
          <td>{dropdown english_writing fluency1 not}</td>
        </tr>
        <tr>
          <td id="swedish_label">Swedish</td>
          <td>{dropdown swedish_reading fluency1 not}</td>
          <td>{dropdown swedish_speaking fluency1 not}</td>
          <td>{dropdown swedish_writing fluency1 not}</td>
        </tr>
        <tr>
          <td id="german_label">German</td>
          <td>{dropdown german_reading fluency1 not}</td>
          <td>{dropdown german_speaking fluency1 not}</td>
          <td>{dropdown german_writing fluency1 not}</td>
        </tr>
        <tr>
          <td id="language_1_label" class="fill-in">{fill-in language_1}</td>
          <td>{dropdown language_1_reading fluency2 choose}</td>
          <td>{dropdown language_1_speaking fluency2 choose}</td>
          <td>{dropdown language_1_writing fluency2 choose}</td>
        </tr>
        <tr>
          <td class="label">Extra language one</td>
        </tr>
        <tr>
          <td id="language_2_label" class="fill-in">{fill-in language_2}</td>
          <td>{dropdown language_2_reading fluency2 choose}</td>
          <td>{dropdown language_2_speaking fluency2 choose}</td>
          <td>{dropdown language_2_writing fluency2 choose}</td>
        </tr>
        <tr>
          <td class="label">Extra language two</td>
        </tr>
      </table>
    </div> <!-- fieldset -->

	<div class="fieldset" id="step10"><div class="legend">Activities</div> <!-- legend -->
      <p class="attend">The following activities, excursions or lodging involve extra costs. Please mark the ones you would like:</p>
      <table>
        <tr>
          <td colspan="2">{checkbox activities_1 Finland trip, July 8 - July 12. Deposit 1.000 SEK. Total cost 2.400 SEK.}</td>
        </tr>
        <tr>
          <td colspan="2">{checkbox activities_2 Lapland trip, July 16 - July 21. Deposit 1.500 SEK. Total cost 3.600 SEK.}</td>
        </tr>
        <tr>
          <td colspan="2">{checkbox activities_3 Värmland trip, July 30 - August 1. Deposit 1.000 SEK. Total cost 2.300 SEK.}</td>
        </tr>
        <tr>
          <td></td>
          <td>{checkbox activities_3_1 rafting}</td>
        </tr>
        <tr>
          <td></td>
          <td>{checkbox activities_3_2 adventure experience}</td>
        </tr>
        <tr>
          <td></td>
          <td>{checkbox activities_3_3 hiking}</td>
        </tr>
        <tr>
          <td colspan="2"><div class="remark"> The non-refundable deposit for the optional trips and the costs for the apartment should be paid together with the advance course payment of 5.000 SEK. The remaining costs should be paid with the final course fee payment.
              <p></p>
          </div></td>
        </tr>
      </table>
    </div> <!-- fieldset -->

	<div class="fieldset" id="step11"><div class="legend">How did you hear about the Uppsala program?</div> <!-- legend -->
      <table>
        <tr>
          <td colspan="2"><label>{checkbox heard_1 Have known about it for several years and have been waiting for the opportune time to apply}</label></td>
        </tr>
        <tr>
          <td><label>{checkbox heard_2 Internet, name of the website:}</label></td>
          <td class="fill-in">{fill-in heard_url}</td>
        </tr>
        <tr>
          <td><label>{checkbox heard_3 Heard about it from friend, teacher, etc: name}</label></td>
          <td class="fill-in">{fill-in heard_name}</td>
        </tr>
        <tr>
          <td><label>{checkbox heard_4 Poster on campus or at}</label></td>
          <td class="fill-in">{fill-in heard_poster_other}</td>
        </tr>
        <tr>
          <td><label>{checkbox heard_5 Read about the program (newspaper etc)}</label></td>
          <td class="fill-in">{fill-in heard_read}</td>
        </tr>
        <tr>
          <td><label>{checkbox heard_6 Requested information from}</label></td>
          <td class="fill-in">{fill-in heard_requested}</td>
        </tr>
      </table>
    </div> <!-- fieldset -->
	
	<div class="fieldset" id="step12"><div class="legend">Disclaimer and agreement</div> <!-- legend -->
      <p id="disclaimer_label">{checkbox disclaimer I understand that the UISS program arrangements, including the course offerings, may be subject to minor modifications}</p>
      <p id="agree_and_pay_label">{checkbox agree_and_pay I have paid a non-refundable application fee of $50 or €30 to complete my application}</p>
      <!-- div id="captcha"> {captcha} </div -->
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